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Quick Tip for Families in Intensive Care: My Husband’s Oxygen Saturation Went Down Rapidly, and Now He’s Back on the Ventilator with a Tracheostomy! 

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is again another question answered from one of our members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com, if you click on the membership section or if you go to intensivecaresupport.org  directly.

So, let’s read out another question from one of our members who says,

“Hi Patrik and team,

My husband tried the bolus feeds method today, prior to that, he had a bit of diarrhea. The night nurse deliberately allowed a lot of air to go into the tube and didn’t use warm water to flush it. The dietitian was trying to discourage me from doing the bolus feeds and printed a long list of disadvantages. I think they deliberately planned this to happen.

My husband’s oxygen level went down rapidly although it came back to 80 to 90 but they did his ABG (Arterial Blood Gas), I think it was in the 40s, and they transferred him back to the ICU and he’s now back on the ventilator with the tracheostomy. We are planning on going home and they kept dragging their feet, finding excuses. If this had happened at home, I would have transferred him back to a hospital I’m more comfortable with. I will seek to transfer him to a different hospital ICU.”

So, this is a client who’s had their husband in ICU for quite some time with the ventilator and tracheostomy. Now, she’s thinking of going home, the problem is that the client is in the U.S., and we don’t have Intensive Care at Home services in the U.S. yet, unfortunately. So, going home will be a challenge.

But let’s look at our response.  Obviously, we’re not mentioning names here. We’re protecting the identity of our clients.

“Thank you so much for your email.

I hope you’re all well and thank you for the updates.

Regarding your husband’s diarrhea, may I know when the diarrhea started? Right after the bolus feeds and what about the feeds or formula, was the formula new, or first time to introduce that kind of feed, or the same feeds he has been receiving every day?

May I know the type of milk? Most renal formula make the stool semi-loose and not formed in character. Are you sure that the milk given is properly stored? Observe the diarrhea for how many days he has been having diarrhea. His diarrhea may be due to other causes, perhaps secretions, spoiled milk, infections, viruses, food allergy, food intolerance, reaction to medicines, or antibiotics in particular.

Anyway, here are the advantages of bolus feeds over continued drip feeding. Bolus feeding is similar to a normal feeding pattern, more convenient, less expensive, and allows freedom of movement for the patient.

Patients with feeding tubes who can tolerate normal amounts of feed can be fed and tried bolus feeding. Most of our pediatric patients are on bolus feeds every 3 hours. Very sick children with disorders in the stomach, breathing, days of recovery from operative procedures, etcetera and other disease conditions are fed by a continuous method or using the feeding pump. Fully awake patients recovering well tried the bolus method since the bolus method is similar to a normal feeding pattern, usually given every 4 to 6 hours frequency in adults. Also depends on every patient’s feeding tolerance.

The disadvantages of bolus feedings are: that they are easily aspirated, especially when fed the wrong way, meaning not in the proper position, feeding while lying flat on the bed. The feeding position is to keep the patient in a sitting or semi-sitting position. The head is elevated or higher than the abdomen so the food content will not go upward to the lungs, leading to aspirations. May also cause bloating, cramping, nausea, and vomiting, especially when you are feeding the patient with a large amount of feeds.

The amount of feeds must be given as per patient tolerance, that’s why the feeding is not given in abruptly large amounts. You can increase the feeds every other feed or as tolerated. For example, you feed your husband at 9 a.m. with 50 ml of milk, then at 12 a.m., you will feed him with another 50 ml of milk again. When he tolerated the 50 ml twice, no vomiting, no nausea, no difficulty of breathing, no bloating of the abdomen noted, et cetera, then at 3 p.m., you can increase the amount of 60 or 70 mls and then observe his tolerance. The increment in the amount of feeds every 3- or 4-hour feeding interval can be increased accordingly.

Always flush the feeding tube with warm or drinking water after feeding to avoid tube obstruction or clogging. Then, allow your husband to remain in a semi-sitting or sitting position after feeding. Don’t put your husband back in a lying position because there is a risk of aspirations. If aspirations happen, his oxygen saturation will drop/decrease, he will have breathing difficulty, abdominal discomfort, nausea, vomiting, etcetera. Always clear the respiratory secrets prior to feeding and always put your husband in the correct feeding position, sitting or semi sitting positions.

What was the ABG (Arterial Blood Gas) result? Have they taken the chest x-ray? If aspiration or feed content happens, the doctor will see it in the chest x-ray film, and they have to keep him off from feeds or hold off the feedings for now.

Is your husband back in ICU and on a ventilator? Did the doctor explain to you and update you on what caused him to be back in the ICU and the ventilator? Any signs of new infections? What are his blood results? Arterial blood gas results in particular? What are his ventilator settings? How often does he need suctioning? Have changed the inner cannula? Does he need a tracheostomy tube change? Those are the questions you should be looking for.

Since your husband is back on a ventilator now, there must be a breathing problem. The doctor might return or resume feeding by pump or continuous feeding method. You can always ask the doctor to update you and explain to you the plan of care for your husband. Of course, get access to medical records urgently.

I also hope that your husband is fully conscious, cooperative, and not having cyanosis or discoloration of the lips like black, color, violet or gray. You mentioned that oxygen saturation is 80 to 90%. It is low. He needs more oxygen and clearance of the airway. The tracheostomy tube might have secretions or obstructions, so have the respiratory therapist suction and clear your husband’s airway for good breathing and ventilation.

You said 40, is that from the blood gas results? Is it PCO2 (partial pressure of carbon dioxide) or carbon dioxide? If it is PCO2, it is within the normal range, what do you mean by 40? If it’s PO2 (partial pressure of oxygen), oxygen in the blood gas, then it’s too low.”

Again, it comes back to that the biggest challenge for families in intensive care is simply that they don’t know what they don’t know  They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. The devil is in the detail in intensive care.

People always come to me, and they say, “Oh, my husband is on the ventilator and he’s on 40.” What does that even mean? When someone is on a ventilator, there’s dozens of numbers on a ventilator screen and you need to understand all of them in order to make informed decisions, have peace of mind, control, power, and inference. You can’t just keep throwing numbers around because there’s many numbers that need to be looked up.

So anyway, with you going home or with you wanting to go home, we have discussed this on the phone that it will be very, very challenging for you to go home by yourself with a tracheostomy and the nasogastric tube. It’ll be very, very challenging. Unfortunately, you’re not in Australia.

For those of you watching who are in Australia, we’re providing Intensive Care at Home nursing in Australia where we send critical care nurses into the home for patients with ventilation, tracheostomy, nasogastric tubes, PEG (Percutaneous Endoscopic Gastrostomy) tubes, anybody that’s medically complex and would be in ICU long-term. We’re looking after them at home and this client here in particularly struggling getting the husband home because there are no services in the U.S. that can provide a similar level of high-quality care.

If you are watching this and you are in Australia, we are NDIS (National Disability Insurance Scheme), TAC (Transport Accident Commission), NIISQ (National Injury Insurance Scheme in Queensland), and DVA (Department of Veteran Affairs) approved service provider. So, please contact us if you need help. But even if you’re in the U.S., reach out to us, we can help you with consulting. We can help you with advocacy. We can help you, potentially finding other service providers in the U.S. We have a network. So, please reach out to us in any case.

If you want your questions answered and you want to become a member of our membership for families of critically ill patients in intensive care, please go to intensivecarehotline.com, click on our membership link, or go to intensivecaresupport.org directly. Also, in the membership, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions intensive care related.

Now, I also offer one-on-one consulting and advocacy for families in intensive care over the phone, via Zoom, via Skype, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly. I talk to you and your families and help you with making sure you can make informed decisions, have peace of mind, control, power, and influence because I asked all the questions that you haven’t even considered asking the intensive care team. Again, you don’t know what you don’t know.

I also represent you in family meetings with the intensive care teams. I have helped hundreds of families in intensive care all over the world to make informed decisions, have peace of mind, control, power, and influence. I’m not exaggerating when I’m saying we have saved some lives, and you can verify that on our testimonial section. You can verify that with our case studies. You can verify that with some client interviews we have done on our podcast.

We also offer medical record reviews in real time so that you can have a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, if you like my videos for families in intensive care, subscribe to my YouTube channel, click the like button, click the notification bell, comment, share the video with your friends and families.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Thank you.

Related Articles:

Quick Tip for Families in Intensive Care: Ventilator Settings and Arterial Blood Gas Results! Quick Tip for Families in ICU: My Loved One’s Not Getting Better and ICU is Adding More Machines and Treatments While on Ventilator! Quick Tip for Families in Intensive Care: Pressure from ICU Doctors for My Husband to Pass Away or Do a Tracheostomy After Only 7 Days in ICU! Quick Tip for Families in Intensive Care: When Should a Tracheostomy be Done for Acute Respiratory Distress Syndrome (ARDS)? Quick Tip for Families in Intensive Care: Grandpa had Cardiac Arrest at 84, ICU on Ventilator 12 Days! Tracheostomy Induced Coma! Can He Recover, Help!